Ask a Doc: Understanding Psoriasis

August is Psoriasis Awareness Month — a time to raise awareness for a condition that, according to the National Psoriasis Foundation, affects more than 8 million Americans and 125 million people worldwide.

Psoriasis is a non-contagious, chronic autoimmune disease that impacts the skin, joints, and often a person’s emotional well-being. The visible symptoms of psoriasis can lead to social stigma and isolation. In this month’s Ask a Doc, we’re taking a closer look at what psoriasis is, how it differs from other skin issues, and what treatment options are available today.

What is psoriasis?

Psoriasis occurs when the immune system mistakenly triggers inflammation that causes skin cells to multiply too quickly. The result is thick, red patches covered with silvery-white scales. These lesions — called plaques — can appear anywhere on the body but are most commonly found on the scalp, elbows, knees, and lower back. They may itch, burn, or crack and bleed.

Psoriasis is a lifelong condition. Symptoms may come and go, but the underlying immune response persists. For many people, managing flare-ups is a physical and emotional challenge.

Can psoriasis affect the joints, too?

Yes. Many people with psoriasis develop psoriatic arthritis, a form of chronic inflammatory arthritis that causes pain, stiffness, and swelling in the joints. It can affect the fingers, toes, wrists, knees, ankles, and even the spine.

Psoriatic arthritis may appear years after skin symptoms (or sometimes even before) and can lead to joint damage if left untreated. Early diagnosis is essential to prevent long-term complications.

Are there signs to look for if I’m concerned about psoriatic arthritis?

Joint pain or swelling, especially in the morning, stiffness that improves with movement, pain in tendons or heels, and changes in fingernails or toenails are the common warning signs. If you have psoriasis and develop joint symptoms, talk to your doctor right away.

How can I tell if I have psoriasis — and not something else?

Psoriasis is often confused with eczema, fungal infections, seborrheic dermatitis, or even plain old dry skin. Unlike eczema, which tends to be itchier and linked to allergies, psoriasis plaques are more well-defined and commonly feature a silvery scale.

Your primary care doctor can evaluate your skin and make an initial diagnosis. Referral to a dermatologist for further evaluation and management is likely, especially for complex or severe cases that require lifelong management.

What causes psoriasis — and what makes it worse?

Psoriasis often runs in families and can be triggered or aggravated by specific factors. Common triggers include stress, infections (such as strep throat), skin injuries or sunburn, cold, dry weather, smoking or heavy alcohol use, and certain medications (like beta-blockers or antimalarials).

What treatments are available today?

While there’s no cure yet, treatment options have expanded dramatically. For mild cases, topical treatments (like corticosteroids or vitamin D creams) may help. Phototherapy can be used for widespread symptoms. For moderate to severe cases, systemic treatments — including pills and biologic injections — reduce inflammation at the immune level.

Treating psoriasis is a big business for the drug companies. If you watch any television at all, you’ve certainly seen ads for many of these biologic drugs. New research shared at the 2025 American Academy of Dermatology meeting highlighted the growing success of biologic therapies like Tremfya®, SKYRIZI®, COSENTYX®, and Otezla®, which target specific immune pathways with fewer side effects.

How can I support someone living with psoriasis or psoriatic arthritis?

The emotional toll of living with psoriasis is real. People often feel judged or avoid social situations because of how their skin looks or how their joints feel.

You can help by avoiding assumptions, learning about the condition, and being sensitive to how they want to talk about it. Most importantly, could you encourage them to seek care? Today’s treatments can make a real difference.

About the Author

Raymond A. James, D.O.

Dr. James joined the Clinic in March 2018 . A graduate of Des Moines University College of Osteopathic Medicine, he completed his residency at Metropolitan Hospital in Grand Rapids, Michigan. He is board certified in emergency medicine and has been awarded fellowship status by the American College of Emergency Physicians. Throughout his medical career, Dr. […]